Epistaxis- Nosebleeds

Nosebleeds occur commonly during childhood. They are most common during the early school aged years and usually requires no diagnostic evaluation.

Most bleeding is from the anterior septum (Kiesselbach's plexus) where there is a large number of blood vessels. This area has little subcutaneous tissue to allow blood vessel retraction that aids in hemostasis.

Common Etiologies

Digital manipulation (NOSE PICKING!)

Dryness of the nasal tissues most commonly during the winter months. Nosepicking increases the risk of bleeding. Rubbing susceptible area on the pillow may lead to bleeding while child is asleep.

Ulcerations of the mucosa

Inflammation of the mucosa secondary to allergies or infections

Bleeding disorders

VonWillebrand's Disease- decrease of VW factor which helps transport factor VIII and affects platelet adhesiveness. May also be associated with low levels of factor VIII

Compression-The correct way to stop the bleeding is to pinch the nose, putting pressure on Kieselbach's plexus while sitting up and bending forward at the waist. Tilt the head forward. This will prevent posterior trickling of blood which can cause nausea and vomiting. This usually works in 5- 10 minutes. This position may also facilitate clot formation.

Nasal packing- If the bleeding is severe, may need to use packing with nasal packs made of Merocel, gelatin (Gelfoam), regenerated cellulose (Surgicel), microfibrillar collagen (Avitene), or Vaseline or Xeroform gauze.

If unable to stop the bleeding, or is recurrent, ENT may need to cauterize the area with silver nitrate.

Fibrin glue

Vaporizer in the room at night to prevent drying of the nasal mucosa. Also cold on bridge of the nose or nape of the neck can stimulate autonomic responses leading to narrowing of blood vessels.

Use of Vaseline or antibacterial ointment to prevent scab formation in the nose that causes itching and increases manipulation.

Cotton swab soaked with Witch Hazel inside the nostril could lead to vasoconstriction of tiny blood vessels.